'It's Not a Choice:' Trying to Understand Suicide

June 8, 2018 -- Mike Williams was a pastor who was boundlessly compassionate to those who knew him. He loved being outdoors. He was smart enough to teach himself computer programming. “He was an amazing man,” says his daughter, Anna Ruth Williams of Atlanta.

He also killed himself at the age of 55.

In coming to terms with his death, there’s one question Anna Ruth has come to loathe above all others: “Why do you think he did it?” She once walked out on a date who asked her that.

“It’s not a choice. When you live in an orbit of despair, it’s not a choice to you. You have no way out. It’s like your final days of cancer. You have no choice. It is eating your body. You are going to pass, right?
The only choice I think you do have to make is to reach out for help,” she says.

Asking “why,” she explains, assumes that there was a single cause, when in reality, people die by suicide for complicated reasons.

Mike Williams was also in the midst of a life transition. He had recently left a church in Denver to accept a post with another congregation in Tennessee. People going through stressful life events -- like relationship problems, job loss, or financial or school difficulties -- have a higher chance of death from suicide. Other things in the environment increase the risk, too, including access to lethal means -- like drugs or guns -- and exposure to suicides in the news or in the community.

With the recent deaths of Kate Spade and Anthony Bourdain in the news this week, health professionals are worried others could follow suit. Studies have shown that the suicide rate rises after intense news coverage of these deaths.

“People hold stars in high esteem. They think, ‘If they could end up suffering and committing suicide, what hope do I have?’ says Robert Dicker, MD. He’s the associate director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, NY.

The last category of things that raise the odds of suicide has to do with a person’s history, including genetics, exposure to a traumatic or violent events in childhood or as an adult, or cultural beliefs that support suicide.

“While we have all these risk factors that we do know about, there’s not a simple formula where if you have four of these, you’re going to die by suicide, or if you have two, but one is really bad, then you’re going to die by suicide. So we don’t have a formula,” says Nadine Kaslow, PhD, professor and vice chairwoman of psychiatry and behavioral sciences at Emory University School of Medicine. She’s also chief psychologist at Grady Memorial Hospital in Atlanta.

“Something else that’s hard is that there are many people who die by suicide that never told someone they were going to do it, so they never even mentioned it,” Kaslow says.

Other experts echo those thoughts, and they say even mental health professionals struggle to identify warning signs.

“This is extremely difficult to pick up on. If people [who are considering suicide] aren’t clear about their actual imminent intent, it’s hard to predict,” says Dicker.

In the wake of Spade and Bourdain’s deaths, and on the heels of new numbers from the CDC showing an increase in suicides across the U.S., the American Psychological Association said suicide prevention should be a public health priority and called for greater access to mental health screening and treatment.

‘I Have to Be Very Careful to Take Care of Myself’

Something that’s especially cruel about suicide is that closeness to one puts others at risk, too. Studies show that the brothers and sisters of someone who’s died by suicide have odds of killing themselves that are two to three times higher than average. The same is true for children and teens who lose a parent to suicide.

Before her father’s death, Anna Ruth says she never considered taking her own life, but over the years, she’s come to understand that’s she’s at risk, too.

“As a survivor of suicide, I have the genetics and I’ve experienced something very traumatic in life,” she says. “I have to be very vigilant when a shoe drops and life gets tough. I have to be very careful to take care of myself.”

Anyone who’s grieving the death of a friend to suicide should understand some fundamental things, Dicker says.

You need to talk about it. If you can’t be open with friends and relatives, seek out local survivor support groups or a trusted professional like a doctor, a school counselor, or a religious leader.

It’s not going to be easy. Grief after a loved one’s suicide is almost always complicated grief. In complicated grief, feelings of sadness and loss are debilitating and don’t improve with time.

Help is available. Medications and counseling can ease the depression, guilt, and self-blame that many survivors feel.

Grief over a suicide can lead people to consider suicide themselves. The National Suicide Prevention Lifeline is 800-273-8255.

For Anna Ruth, celebrating her father’s life is important, too. She doesn’t remember the exact day that he died. That’s something she’s chosen not to focus on. Instead, she celebrates her dad’s birthday.

“I encourage people to find new traditions, because your traditions are going to completely change,” she says.

“Father’s Day is hell for me,” says Anna Ruth, who owns her own public relations firm. “The past several years, I’ve always done something special with an employee of mine who also lost her dad to suicide. Finding comfort in other people on those holidays is very powerful,” she says.